HESI Maternal Complications Exam
(2026 Update)|| Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section 1: Hypertensive Disorders of Pregnancy (Questions 1–15)
1. A primigravida at 34 weeks gestation presents with blood pressure 168/110
mmHg and 3+ proteinuria. She reports a frontal headache and epigastric
pain. Which nursing action is priority?
• A) Administer labetalol IV push
• B) Prepare for magnesium sulfate infusion
• C) Assess deep tendon reflexes and clonus
• D) Notify the provider immediately for possible delivery
Rationale: Severe preeclampsia with symptoms (epigastric pain, headache)
indicates possible HELLP syndrome or eclampsia. Delivery is the definitive
treatment after 34 weeks.
2. A patient with severe preeclampsia is receiving magnesium sulfate. Which
finding indicates magnesium toxicity?
• A) Respiratory rate of 14 breaths/min
• B) Urinary output 35 mL/hour
• C) Absent patellar reflexes
• D) Serum magnesium level 4.5 mg/dL
*Rationale: Absent DTRs is a sign of magnesium toxicity (normal level 4–7
mg/dL therapeutic; >8 toxic). Respiratory depression and oliguria (<30
mL/hr) are later signs.*
,3. Which medication is the antidote for magnesium sulfate toxicity?
• A) Naloxone
• B) Calcium gluconate
• C) Protamine sulfate
• D) Vitamin K
Rationale: Calcium gluconate (1 g IV push over 3–5 min) reverses
respiratory depression and cardiac effects of magnesium toxicity.
4. A nurse is caring for a postpartum patient with eclampsia who had a seizure
1 hour ago. Which position is safest?
• A) Supine with legs elevated
• B) Left lateral recumbent
• C) Trendelenburg
• D) Supine with head flat
Rationale: Left lateral improves uterine perfusion, reduces aspiration risk,
and prevents vena cava compression.
5. Which laboratory finding is most concerning in a patient with suspected
HELLP syndrome?
• A) Platelets 120,000/mm³
• B) AST 250 U/L and platelets 50,000/mm³
• C) Hemoglobin 11 g/dL
• D) Creatinine 0.9 mg/dL
*Rationale: HELLP = Hemolysis, Elevated Liver enzymes (>70 U/L), Low
Platelets (<100,000). Platelets <50,000 severe.*
6. A patient with chronic hypertension at 28 weeks has BP 150/95 mmHg. She
is prescribed labetalol. Which finding requires immediate intervention?
• A) Fetal heart rate 140 bpm
• B) Maternal heart rate 58 bpm
• C) Maternal report of shortness of breath
, • D) Blood glucose 95 mg/dL
Rationale: Labetalol can cause heart failure in predisposed patients. SOB
suggests pulmonary edema; hold medication and assess lungs.
7. Which assessment differentiates preeclampsia from gestational
hypertension?
• A) Blood pressure >140/90
• B) Proteinuria ≥300 mg/24 hr
• C) Edema of hands and face
• D) Onset after 20 weeks
Rationale: Proteinuria defines preeclampsia. Gestational hypertension lacks
proteinuria or end-organ damage.
8. A patient with mild preeclampsia at 36 weeks is being discharged. Which
instruction is most important?
• A) "Limit fluid intake to 1 L/day"
• B) "Report any visual changes or right upper quadrant pain
immediately"
• C) "Take aspirin 81 mg daily"
• D) "Bed rest in supine position"
Rationale: Visual changes (scotomata) and RUQ pain suggest worsening
preeclampsia/HELLP.
9. During magnesium sulfate infusion, the nurse notes a respiratory rate of 10
breaths/min. What is the first action?
• A) Increase oxygen to 10 L/min
• B) Discontinue the magnesium infusion
• C) Administer calcium gluconate
• D) Call a code blue
Rationale: RR <12 indicates toxicity. Stop infusion first, then give calcium
gluconate, then call provider.
10. Which fetal complication is associated with severe preeclampsia?
(2026 Update)|| Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section 1: Hypertensive Disorders of Pregnancy (Questions 1–15)
1. A primigravida at 34 weeks gestation presents with blood pressure 168/110
mmHg and 3+ proteinuria. She reports a frontal headache and epigastric
pain. Which nursing action is priority?
• A) Administer labetalol IV push
• B) Prepare for magnesium sulfate infusion
• C) Assess deep tendon reflexes and clonus
• D) Notify the provider immediately for possible delivery
Rationale: Severe preeclampsia with symptoms (epigastric pain, headache)
indicates possible HELLP syndrome or eclampsia. Delivery is the definitive
treatment after 34 weeks.
2. A patient with severe preeclampsia is receiving magnesium sulfate. Which
finding indicates magnesium toxicity?
• A) Respiratory rate of 14 breaths/min
• B) Urinary output 35 mL/hour
• C) Absent patellar reflexes
• D) Serum magnesium level 4.5 mg/dL
*Rationale: Absent DTRs is a sign of magnesium toxicity (normal level 4–7
mg/dL therapeutic; >8 toxic). Respiratory depression and oliguria (<30
mL/hr) are later signs.*
,3. Which medication is the antidote for magnesium sulfate toxicity?
• A) Naloxone
• B) Calcium gluconate
• C) Protamine sulfate
• D) Vitamin K
Rationale: Calcium gluconate (1 g IV push over 3–5 min) reverses
respiratory depression and cardiac effects of magnesium toxicity.
4. A nurse is caring for a postpartum patient with eclampsia who had a seizure
1 hour ago. Which position is safest?
• A) Supine with legs elevated
• B) Left lateral recumbent
• C) Trendelenburg
• D) Supine with head flat
Rationale: Left lateral improves uterine perfusion, reduces aspiration risk,
and prevents vena cava compression.
5. Which laboratory finding is most concerning in a patient with suspected
HELLP syndrome?
• A) Platelets 120,000/mm³
• B) AST 250 U/L and platelets 50,000/mm³
• C) Hemoglobin 11 g/dL
• D) Creatinine 0.9 mg/dL
*Rationale: HELLP = Hemolysis, Elevated Liver enzymes (>70 U/L), Low
Platelets (<100,000). Platelets <50,000 severe.*
6. A patient with chronic hypertension at 28 weeks has BP 150/95 mmHg. She
is prescribed labetalol. Which finding requires immediate intervention?
• A) Fetal heart rate 140 bpm
• B) Maternal heart rate 58 bpm
• C) Maternal report of shortness of breath
, • D) Blood glucose 95 mg/dL
Rationale: Labetalol can cause heart failure in predisposed patients. SOB
suggests pulmonary edema; hold medication and assess lungs.
7. Which assessment differentiates preeclampsia from gestational
hypertension?
• A) Blood pressure >140/90
• B) Proteinuria ≥300 mg/24 hr
• C) Edema of hands and face
• D) Onset after 20 weeks
Rationale: Proteinuria defines preeclampsia. Gestational hypertension lacks
proteinuria or end-organ damage.
8. A patient with mild preeclampsia at 36 weeks is being discharged. Which
instruction is most important?
• A) "Limit fluid intake to 1 L/day"
• B) "Report any visual changes or right upper quadrant pain
immediately"
• C) "Take aspirin 81 mg daily"
• D) "Bed rest in supine position"
Rationale: Visual changes (scotomata) and RUQ pain suggest worsening
preeclampsia/HELLP.
9. During magnesium sulfate infusion, the nurse notes a respiratory rate of 10
breaths/min. What is the first action?
• A) Increase oxygen to 10 L/min
• B) Discontinue the magnesium infusion
• C) Administer calcium gluconate
• D) Call a code blue
Rationale: RR <12 indicates toxicity. Stop infusion first, then give calcium
gluconate, then call provider.
10. Which fetal complication is associated with severe preeclampsia?
